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Personhood and Persistent Vegetative State

Personhood and Persistent Vegetative State. What Is PVS?. Permanent unconsciousness NOT coma-- sleep wake cycles Random movements No purposeful movements Cannot perceive any environmental stimuli (including pain) Spontaneous breathing after initial phase. What is PVS? Cont.

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Personhood and Persistent Vegetative State

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  1. Personhood and Persistent Vegetative State

  2. What Is PVS? • Permanent unconsciousness • NOT coma-- sleep wake cycles • Random movements • No purposeful movements • Cannot perceive any environmental stimuli (including pain) • Spontaneous breathing after initial phase

  3. What is PVS? Cont. • Brain stem intact • Cerebral hemispheres irreversibly damaged • No single sign is conclusively diagnostic • Can be diagnosed with confidence 1-12 months after initial injury depending on age, nature of injury

  4. Persistent Vegetative State = Higher Brain Death

  5. Cerebrum Brain stem Cerebellum

  6. Legally alive Loss of cerebral function only Permanently unconscious Can maintain for up to 37 years Rare cases of some recovery Legally dead Loss of cerebral + brain stem Permanently unconscious Can maintain for up to 3 months No cases of any recovery PVS vs. Whole brain death

  7. Not truly a type of “coma” Spontaneous respiration Sleep-wake cycles Various reflexes but no purposeful movement No clear list of tests Deepest possible coma No spontaneous respiration No sleep-wake cycles Spinal reflexes only Unambiguous diagnosis PVS vs. Whole brain death

  8. Importance of Personhood • Basic moral ideal: respect for persons • In almost all cases, a living human being is a person • Borderline cases • Human fetus • PVS • Anencephalic infant

  9. Mental capacity view of personhood • Favored by Arras and many others • Person = potential bearer of rights and interests • To have interests it must make a difference to you for your own sake what is done to you • To make a difference must have minimal level of awareness

  10. Mental capacity • If one irreversibly lacks that minimal level of awareness of self and surroundings, not a “person” in the strict moral sense • Applies clearly to PVS: Former person, no longer one • Applies clearly to anencephalic infant: never can become a person

  11. Risks? • “Nonperson” status in past often used as mode of discrimination against minorities (Nazis, etc.) • Reply: Mental capacity is different because it clearly made a difference to victims of Nazis what happened to them • Test: what would I want done to and for myself, if I were later to enter a PVS?

  12. Criterion for death? • Proposal: We care about the deaths of persons, not about the deaths of human bodies • Therefore should have higher brain not whole brain criterion for death • Practical problem: ease and certainty of diagnosis

  13. A differing (religious) view • All living human beings are worthy of respect and dignity • Ongoing life is always a “benefit” • A feeding tube thus provides a benefit with very little if any burden • PVS is an extreme disability so nontreatment mean treating the disabled as less than full persons

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